Evidence-based practice is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise, and patient preferences. It leads to greater professional satisfaction, better patient outcomes, and reduced health care costs.

Evidence-based nursing practice solves problems encountered by nurses when they carry out four steps:

• Clearly identify the issue or problem-based on accurate analysis of current knowledge and practice.
• Search the nursing literature for relevant research.
• Evaluate the research evidence using established criteria regarding scientific merit.
• Choose interventions and justify the selection with the most valid evidence.

It all sounds wonderful, but the reality is that nurses in the United States are not consistently using evidence-based practice. A sample of 350 nurses showed that only 34.5% agreed or strongly agreed that their colleagues consistently used EBP in treating patients.

Barriers and Incentives to Evidence-Based Nursing

The incorporation of research into nursing practice has been slow for two primary reasons: lack of time and an organizational culture that does not support it.

One day I read a research study about injecting patients with heparin. The nursing researchers concluded that it was not necessary to inject patients in the abdomen; heparin (or other injectable anticoagulants) is absorbed just as well from an arm or leg. “Great”, I thought and thereafter, while working as a staff nurse, I started avoiding the abdomen and using patients’ arms for this kind of injection. When I talked to my colleagues and patients about the research study’s conclusions, I encountered disbelief and skepticism. After all, if this study was right, that meant that other nurses were unnecessarily using the abdomen. I learned to quietly inject the patients in the arms without providing the education.

It can take up to ten years or twenty years to incorporate scientifically validated interventions into mainstream practice. This process is slow for several reasons:

1. The revision of nursing textbooks used in the preparation of new nurses is a lengthy process, spanning several years.
2. Many nurses do not have the time or expertise to periodically review existing databases and literature.
3. There is not usually a system in place to track, review, teach, implement, and evaluate “best” practices. Such a system would include re-engineering, process improvement, patient care redesign, clinical resource management, and productivity benchmarking.
4. Establishing, implementing, and updating evidence-based clinical practice guidelines to fit institutional requirements is labor-intensive and time-consuming.
5. Nurses who have not had a research course in their education may have insufficient skills to evaluate research. This applies to most graduates of associate’s, diploma, and some baccalaureate programs. The majority of nurses in practice today were educated before 1990 and the widespread use of electronic information resources and personal computers.56
6. Research-based protocols may be successfully disseminated to and used by clinical staff, but downsizing, staff turnover, and lagging motivation may undercut the consistent application of the evidence-based practice.
7. High-quality evidence may not exist for the clinical decisions that have to be made.

The study about not needing to use the abdomen for anticoagulants came out in the 1990s. I’ll bet you that you’ll still see medical records documenting abdominal subcutaneous injections of anticoagulants. It is because “We’ve always done it that way.”

Sources: Modified from “Foundations of Nursing Practice” in  Nursing Malpractice, Fourth Edition, 2011

“Barriers to implementing evidence-based practice remain high for U.S. Nurses”, AJN, December 2012, Vol 112, No. 12, page 15

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